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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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SANNER, MARTY KELL       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 3811 WEST GORE BLVD
SUITE 6
LAWTON OK 73505-6328

Address last updated on 5/7/2024
Phone #: (580) 353-7777
Fax #: (580) 354-5930
County: COMANCHE
License: 18448
Dated: 7/1/1993
Expires: 7/1/2025
Training Issued: 6/26/1992
Training Expires: 6/30/1993
License Type: Medical Doctor
Specialty: Internal Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 1992
CME Year: 2027
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications:
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Comanche County Memorial Hospital
Lawton, OK
Southwestern Medical Center
Lawton, OK
Locations: Hours: Languages:
3811 WEST GORE BLVD
SUITE 6
LAWTON OK 73505-6328

Phone #: (580) 353-7777
Fax #: (580) 354-5930
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
MARY DERRICO APRN 49043
AUDREY OBINERO APRN 114594

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